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Case Study Analysis

The most likely diagnosis for the patient in the case scenario is acute gouty arthritis. Acute gouty arthritis is an inflammatory arthropathy that commonly affects a single joint, usually the first metatarsophalangeal joint (Ragab et al., 2017). In acute gouty arthritis, monosodium urate (MSU) crystals are deposited in the soft tissue of the affected joint. The presence of MSU crystals triggers an acute inflammatory response in the affected joint space that involves the soft tissue, including the synovium, and results in severe pain, swelling of the joint, erythema, and loss of joint movement as evident in the case scenario (Towiwat et al., 2019). Fever and chills are constitutional manifestations of the inflammatory response in the affected joint (Ragab et al., 2017).

Severe pain and intense swelling resulting from the inflammatory response in the affected joint limit the ability of the patient to use the joint (Ragab et al., 2017). In the above case scenario, the pain limits weight-bearing and may consequently impair the patient’s physical mobility. The presence of severe pain and systemic symptoms such as fever and chills may potentially result in significant debilitation of the patient.

Similarly, an association has been found between ethnicity and the risk of developing incident gout. Specifically, African American ethnicity/race increases the risk of incident gout (Singh et al., 2016). Since the patient in the case study is a white male, the ethnic-racial variable is insignificant. However, the patient has both hypertension and diabetes mellitus, which are established risk factors for gout. The patient is also on hydrochlorothiazide, a thiazide diuretic that may increase serum levels of uric acid (Ragab, et al., 2017). These risk factors predispose the patient to subsequent attacks of acute gouty arthritis, which may be polyarticular. Frequent acute attacks will derail the patient’s quality of life and predispose them to joint damage (Ragab, et al., 2017).


Ragab, G., Elshahaly, M., & Bardin, T. (2017). Gout: An old disease in new perspective–A review. Journal of advanced research8(5), 495-511.

Singh, J. A., Bharat, A., Khanna, D., Aquino-Beaton, C., Persselin, J. E., Duffy, E., … & Khanna, P. P. (2016). Racial differences in health-related quality of life and functional ability in patients with gout. Rheumatology, kew356.

Towiwat, P., Chhana, A., & Dalbeth, N. (2019). The anatomical pathology of gout: a systematic literature review. BMC musculoskeletal disorders20(1), 140.


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In your Case Study Analysis related to the scenario provided, explain the following:

  • Explain both the neurological and musculoskeletal pathophysiologic processes of why the patient presents these symptoms.
  • Explain how the highlighted processes interact to affect the patient.
  • Explain any racial/ethnic variables that may impact physiological functioning
  • How these processes interact to affect the patient.



My patient is a 58-year-old obese white male presents to ED with chief complaint of fever, chills, pain, and swelling in the right great toe. He states the symptoms came on very suddenly and he cannot put any weight on his foot. Physical exam reveals exquisite pain on any attempt to assess the right first metatarsophalangeal (MTP) joint. Past medical history positive for hypertension and Type II diabetes mellitus. Current medications include hydrochlorothiazide 50 mg po q am, and metformin 500 mg po bid. CBC normal except for elevated sedimentation rate (ESR) of 33 mm/hr and C-reactive protein (CRP) 24 mg/L. Metabolic panel normal. Uric acid level 6.7 mg/dl.

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